My aunt was denied Medicaid. Can the nursing home sue us for payment?

Cmckimm asked...

If Medicaid was denied because my aunt's SSI and pension was over $2,000 and she died after Medicaid made that decision, and her house had a mortgage on it, can the nursing home sue us for payment? We are her nieces and nephew, she did not have any children. This is in New York.

Expert Answer

Barbara Repa, a Caring.com senior editor, is an attorney, a journalist specializing in aging issues, and the author of Your Rights in the Workplace (Nolo), now in its 10th edition.

Getting to the bottom of your situation may require you to do a bit of talking and wading through some fine print.

First and foremost, you want to be sure that the decision denying your aunt Medicaid was correct. Many older or disabled people, for example, are able to technically exceed Medicaid's income limits and still qualify for benefits if a certain portion of their income goes to paying medical bills. And Medicaid workers are often forced to take another look at eligibility denials, especially once there is an active and informed advocate to force them to do it. Doublecheck the math done in your aunt's case by contacting the local Department of Social Services, which you can find at http://www.health.state.ny.us/health_care/medicaid/ldss.htm.

Second, make sure the nursing home is within its rights in claiming it is owed money. When pressed, the facility should be able to provide an itemized billing for the charges claimed"”along with its written policy on acceptable funding sources.

If the nursing home administrator is not helpful, try contacting the New York State Office of Long-Term Care Ombudsman at www.ltcombudsman.ny.gov. Impartial representatives there are charged with investigating and smoothing over complaints about nursing home care and operations"”and can sometimes be helpful in untangling billing matters, too.

Finally, if the Medicaid denial is accurate and the nursing facility is rightfully owed money, it may be entitled to claim the amount it is due from your aunt's estate"”and if you are your aunt's sole heirs, that may mean money coming from your pockets. But even in this worst case scenario, there may be some wiggle room for you to negotiate the amount it will take to settle the bill.

If a substantial sum of money is involved, it may be worth your time and money to consult an attorney for help. But not just any attorney will do. Make sure you find someone who is experienced in handling elder law and estate planning issues.